Specialty Choices Among Medical Students and Interns in Egyptian Accredited and Non Accredited Faculties of Medicine

12 Current Science International 1(1): 12-19, 2011 ISSN: 2077-4435

Specialty Choices Among Medical Students And Interns In Egyptian Accredited And Non Accredited Faculties Of Medicine.

Omnia S. El Seifi and Eman M. Mortada

Department of Community, Environmental and Occupational Medicine, Faculty of Medicine – Zagazig University, Egypt.

ABSTRACT

Background: Worldwide, the process of specialty choices and how the graduates of medical schools select their areas of specialization is a growing concern. Objectives: 1) detect and compare specialty preference among Zagazig (non accredited) and Suez Canal (accredited) Universities' medical students and interns 2) study important factors that are considered when choosing the specialties and 3)determine if there is difference in choosing specialties according to gender and accreditation. Methods: A cross-sectional study was conducted from January 2011 to May 2011 in Zagazig and Suez Canal faculties of medicine. Using multistage sampling technique, a sample from interns, 4th, 5th and 6th year medical students was included in the study. The sample size was (640) out of 2800 in Zagazig faculty of medicine and (374) out of 681 in Suez Canal faculty of medicine. Results: General Surgery have the 1st rank among other specialties in Zagazig faculty of medicine (17.5%) while Obstetrics & gynecology was the 1st choice in Suez Canal Faculty of Medicine (18.0%) with no significant difference between them except for Family medicine specialty which was significantly higher in Suez Canal Faculty of Medicine. Male choices were higher than females with significant differences in the following specialties; General Surgery, Ophthalmology, and Anesthesiology in both universities in addition to Radiology in Suez Canal University. There were no significant difference in most of factors underlying specialty choice between the two faculties except for career opportunities in the Zagazig faculty of medicine and role model in the specialty in Suez Canal faculty of medicine . Regarding gender difference, there were significant differences in nearly all factors in both groups except for family expectations in Zagazig University and role model of specialty in Suez Canal University. Conclusions: Our study revealed similarities and differences in specialty preferences and factors influencing these choices among male and female students in both faculties. The main factors affecting specialty choices were students' interest in the career and social aspects and responsibilities with unclear role of accreditation in choosing specialty.

Key words: Specialty choices, medical students and health officers, accreditation.

Introduction

Medical school graduates are an important source of a country’s physicians. Choosing their medical specialty is one of the most important decisions they will face in their medical career, as from one hand; their choices decide the manpower distribution among different medical specialties all over the country, and from the other hand finding a specialty that suits the strengths, weaknesses, lifestyle, intellectual challenge, and research potential—among other factors—that agree with each one of them is not an easy process. Determining how the graduates of these schools select their areas of specialization is essential to achieving a balanced distribution of doctors among all specialties (Pei et al., 2006). Worldwide, the process of specialty choices and the distribution of physician specialization is a growing concern, as these choices may not meet community needs and lead to shortage of physicians in some specialties which may be a problem in certain countries (Brotherton et al ., 2004). It was often believed that selcting a speciality is only a process of personal choice. While in fact there are other important fators influncing it such as; economic factors, social expectation, training opportunnities, educational experiances and controllable life style which play important roles in the decision of the students and interns in choosing their specialities. (Anzllotti et al., 2001). Recent studies show that gender of medical students or interns plays an important role in choosing the type of speciality as it was found that Lifestyle, role models, and expectations associated with gender shape their career plans (Salter, 2007; Fukuda and Harada, 2010). Educational accreditation is a type of quality assurance process under which services and operations of educational institutions or programs are evaluated by an external body to determine if applicable standards are met. If standards are met, accredited status is granted by the agency (Global Standards for Excellence in Education, 2011). Accreditation of medical faculties ensures quality medical education leads to quality health care. National Authority for Quality Assurance & Accreditation of Education –Egypt (NAQAAE) is the accrediting body for all Egyptian educational institutions in Egypt since year 2007, aiming to support Egyptian Corresponding Author: Omnia Elseifi, Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Egypt. E-mail: [email protected]. 13 Curr. Sci. Int. 1(1): 12-19, 2011 educational institutes by fostering their quality assurance practices specially those related to student centered education and career guidance (NAQAAE, 2011). Faculty of Medicine, Suez Canal University (FOM-SCU) was established as the first community- oriented/based, problem-based and student-centered medical school in Egypt, this system has been shown to develop better psychosocial skills in students and a better attitude toward patients than students trained in more traditional ways (Caminal et al., 2004). Also the faculty adopting the quality standards and principals and was accredited since (15/5/2010) to be one of the first faculties of medicine which is accreted in Egypt. As there is a continuous seeking of our medical faculties (including faculty of medicine, Zagazig University) for accreditation in addition to scarcity of national data and researches about specialty choices and factors underlying them. The objectives of our study were to: 1) detect and compare specialty preference among Zagazig and Suez Canal Universities' medical students and interns, 2) study important factors that are considered when choosing the specialties and 3) determine if there is difference in chosen specialty according to gender and accreditation.

Subjects and methods:

Study design and setting:

A cross-sectional study was conducted from January 2011 to May 2011 in two faculties of medicine in Zagazig and Suez Canal Universities.

Study sample and procedure:

Using multistage sampling technique, a random sample from interns, 4th, 5th and 6th year medical students was included in the study. The sample size was (640) out of 2800 in faculty of medicine Zagazig University and (374) out of 681 in faculty of medicine Suez Canal University. Two class rooms (seminars) from each grade in each faculty (regarding medical students) and two shifts in two randomly chosen clinical specialties (General surgery and pediatrics for interns) were randomly selected then the selected classes and shifts were included as cluster where all available students & interns were interviewed. We include three different grades of medical students beside interns due to expected to year to- year fluctuations in the number and percent of medical students choosing different specialties, and attitude change that may occur with time. Students from 1st, 2nd and 3rd grades were excluded from the study because they are to some degree away from exposure to clinical experience in the early years of medical studies and they may haven’t formulated a complete picture about clinical specialties.

Tools of the study:

The data were collected after verbal consent from participants through a self administrated questionnaire including data about: age, sex, grade, preferred specialty (the first choice only), lastly they are asked about factors that were considered when choosing their specialty choices as;  Family expectations; what the family encourage and expect the student to be in the future.  Career opportunity; the future opportunity of the career for promotion.  Ability to establish their own practice; the level of difficulties to establish one’s own practice, including the practice cost, malpractice costs and practice risk.  Role model in the specialty; referring to the behavior of supervisors, or residents that leads to good impression.  Work related hazards; the incidence of exposure to infections, such as infectious hepatitis, or other infectious diseases.  Training period; length of training required and working hours.  High and stable future income; financial rewards relative to other specialties.  Prestige of specialty; in relation to other medical specialties.  Related life style; personal free time for leisure, family and control of total weekly hours spent on professional responsibilities.  Type and number of patients served and the strength of specialty in job market. These factors were based on similar published studies (Dorsey et al., 2005 ; Pei et al., 2006; Scott et al., 2008 and Fukuda and Harada, 2010). Answer was either by (Yes or No) and only those who choose the answer “Yes” were presented in tables. The questionnaire was pre-tested on 30 students from different grades to determine the response and applicability of it and changes were made accordingly. Ethical aspect and administrative approach: necessary official permission was taken out from each faculty. An informed verbal consent was obtained from students and interns.

14 Curr. Sci. Int. 1(1): 12-19, 2011

Data analysis:

The collected data were computerized and statistically analyzed using SPSS (Statistical Package for Social Science) version 19 (IBM, 2010). Percentage for qualitative variables and mean and standard deviation for quantitative variables were calculated. Chi square was calculated to compare between choices between two faculties, gender role in specialties and factors affecting specialty choices. P value (< 0.05) was considered significant difference.

Results:

Table(1) showed the general characteristics of medical students and interns in Zagazig and Suez Canal Universities where they have nearly an equal age; (21.4±1.3) in Zagazig University and(21.2±1.1) in Suez Canal University, most of them were males; (67.03%), (59.9%) respectively and interns (32.81%) in Zagazig university and (31.81%) in Suez Canal University Rank of the first career choice of medical students and interns in our two faculties was illustrated in Fig (1); where General Surgery have the 1st rank in faculty of medicine, Zagazig University (17.5%) while Obstetrics& gynecology was the 1st one in Faculty of Medicine, Suez Canal University (18.0%) and Rheumatology was the last chosen specialty in both faculties (2.2%), (0.8%) respectively. By comparing first career choice of medical students and interns in Zagazig University and Suez Canal University we found from Table(2) that there was no significant difference between two faculties except for family medicine specialty which was highly significant in Faculty of Medicine, Suez Canal University(16.5%) in relation to faculty of medicine, Zagazig University(3.1%). Fig (2) demonstrate Pattern of career choices of medical students and interns by gender in Zagazig and Suez Canal Universities where it was found that male choices were higher with significant difference in Zagazig University regarding the following specialties; General Surgery (261%), Ophthalmology(10.7%) ENT (5.8%) and Anesthesiology (5.1%) while female choices were of higher significant difference in Dermatology (18.0 %), Rheumatology (9.0%), Family Medicine (7.6%) and Academic specialties (24.2%). As regarding Suez Canal University; male choices were significantly higher in General Surgery (19.6%), Radiology (12.0%), Ophthalmology (7.6%), Anesthesiology (5.4%) and ENT (4.0%) and from the other side female choices were significantly higher in Pediatrics (19.3%), Academic specialties (13.3%) and Dermatology (3.3%). As regard factors considered in chosen specialty by male and female medical students and interns in Zagazig and Suez Canal Universities; Table (3): showing that there was no significant difference in most of the factors between two faculties except for career opportunities in faculty of medicine, Zagazig University (75.93%) and Role model in the specialty in faculty of medicine Suez Canal University (79.14). Fig (3) shows Factors considered in chosen specialty by male and female medical students and interns in Zagazig and Suez Canal Universities, where there was significant difference in nearly all factors in both groups except for family expectations in Zagazig University and role model of specialty in Suez Canal University, the highest male percentage(100.0%) was in career opportunities, ability to establish one’s own practice (private) in both faculties in addition to high and stable future income in Suez Canal University, while highest female percentage was in no or little work related hazards of infection in Zagazig University (96.7%) and life style related to specialty is controllable In Suez Canal university(98.7%)

Table 1: General characteristics of medical students and interns in Zagazig and Suez Canal Universities. Variables Zagazig University Suez Canal University Age in years: Mean age ± (SD) years 21.4±1.3 21.2±1.1 No (640) % (100) No (374) % (100) Sex: Male 429 67.03 224 59.9 Female 211 32.97 150 40.1 Grade: 4th year 100 15.63 65 17.37 5th year 136 21.25 80 21.39 6th year 194 30.31 110 29.41 Interns 210 32.81 119 31.81

15 Curr. Sci. Int. 1(1): 12-19, 2011

ENT: Ear, Nose &Throat

Fig. 1: Ranking of the first career choice of medical students and interns in Zagazig and Suez Canal Universities.

Table 2: Comparing first career choice (arranged alphabetically) of medical students and interns in Zagazig and Suez Canal Universities. Specialty Zagazig University Suez Canal University x2 P No % No % Academic Specialties 51 8.0 20 5.3 2.10 0.1468 Anesthesiology 23 3.6 14 3.7 0.00 0.9593 Cardiology 26 4.1 12 3.2 0.27 0.6034 Dermatology 32 5.0 10 2.7 2.65 0.103 ENT 25 3.9 9 2.4 1.21 0.2716 Family medicine 20 3.1 62 16.5 55.68 0.0000* General surgery 112 17.5 50 13.3 2.70 0.1002 Internal medicine 58 9.0 26 7.0 1.12 0.289 Obstetrics& gynecology 87 13.6 67 18.0 3.094 0.0785 Ophthalmology 51 8.0 20 5.3 2.10 0.1468 pediatrics 52 8.1 44 11.7 3.24 0.0720 Radiology 62 9.7 31 8.3 0.40 0.5275 Rheumatology 14 2.2 3 0.8 1.97 0.1602 Others 27 4.2 7 1.8 3.32 0.0683 Total 640 100.00 374 100.0 *Significance difference (p<0.05)

16 Curr. Sci. Int. 1(1): 12-19, 2011

*Significance difference (p<0.05)

Fig. 2: Distribution of career choices of medical students and interns by gender in Zagazig and Suez Canal Universities.

Table 3: Factors considered when chosing specialty by male and female students and interns in Zagazig and Suez Canal Universities. Factors Zagazig University Suez Canal University (No=640) (No=374) χ² p No % No % Family expectations 511 79.84 287 76.73 1.17 0.277 Career opportunities 486 75.93 239 63.90 16.18 0.000* Ability to establish one’s own practice (private) 432 67.50 244 65.24 0.44 0.504 Role model in the specialty 408 63.75 296 79.14 25.64 0.000* Opportunities to do procedure 491 76.71 285 76.20 0.01 0.912 No or little work related hazards of infection 386 60.31 221 59.09 0.10 0.751 Training period is easy and short 401 62.65 245 65.50 0.71 0.398 Type and number of patients served 283 44.21 173 46.25 0.32 0.572 Has current strength in job market 430 67.18 238 63.63 1.17 0.279 High and stable future income 479 74.84 259 69.25 3.45 0.063 Prestige of specialty 447 69.84 260 69.51 0.00 0.969 Life style related to specialty is controllable. 460 71.87 250 66.84 2.61 0.106 *Significance difference (p<0.05)

17 Curr. Sci. Int. 1(1): 12-19, 2011

*Significance difference (p<0.05)

Fig. 3: Factors considered when Chosing Specialty by male and female students and interns in Zagazig and Suez Canal Universities.

Discussion:

During the period of medical study, medical students exposed to a variety of experiences in many specialties. These experiences are so important because they form the basis for the student’s ultimate career choice. A cross sectional study was conducted to compare the choices of two groups of students and interns; one from faculty of medicine that seeks accreditation (Zagazig University) and another accredited one (Suez Canal University). Our results demonstrate that our sample in both faculties has nearly equal age and most of them were males and interns. Regarding the selected choices by our students and interns we found that they select the same range of specialties in both universities. The first specialty choice of our medical students was general surgery in Zagazig University group (17.5%) and Obstetrics &gynecology in the Suez Canal group (18%) which is agreed with the finding of other studies done to investigate career choices (Huda and Yousuf, 2006; Aslam et al. , 2011) and this may be considered to great extent indifferent between both faculties as both of these specialties belongs to major general specialties of medicine also they depends on technique and surgical procedure. On viewing other specialty choices of both groups we can found that the choices were nearly similar where they were ranged from major "hot" specialties as General Surgery, Obstetrics &Gynecology, Pediatrics and Internal medicine to other "cold" specialties as; Cardiology, Rheumatology, Dermatology, Ophthalmology, Radiology and Anesthesiology, beside presence of Family medicine which reflects national interest in this specialty which has high rank of choice (2nd rank) in Suez Canal's students while it was (12th) among Zagazig university's students. Also we noticed that Academic specialties have a place in the top 13 specialty choices(the most chosen one was microbiology specialty and the least was pharmacology) which were mainly chosen by female students as they found them more stable , comfortable and satisfy their needs in the same time. These ranges of chosen specialties are coordinate with the results of other studies (Aslam et al., 2011). When comparing the chosen specialties between two faculties we found that there were no significance differences between their choices except for family medicine where it was significantly higher in Suez Canal

18 Curr. Sci. Int. 1(1): 12-19, 2011 group compared to Zagazig University group. This may be due to that in faculty of medicine, Suez Canal University the family medicine department was established since longer time as a separate department with a full capacity of staff members as well as the great interest of the faculty with community health problems and community based learning so a lot of the students accept the idea to be a family health practitioner while in Zagazig University the family medicine department is still a growing department also the students and interns undergo traditional way of learning or patient centered study (except in their study in community medicine department) which was reflected on their thinking to be specialist rather than general practitioner. Although the females in our study represented about from third to fourth of our sample, they were under- represented in their choices of surgical specialties and technical ones in both group of faculties ,while we can found that female choices were higher in less technical specialties and relatively comfortable ones (except their choice for Obstetrics& Gynecology in Suez Canal University) with significant difference in Dermatology and Academic specialties in both universities , Rheumatology & Family medicine in Zagazig University and Pediatrics in Suez Canal University. We can say in another word that our female students in both groups were more interested in what is called "Controllable lifestyle specialties" which have been defined as those that allow more personal time free of practice requirements for leisure, family, and control of total weekly hours spent on professional responsibilities (Bundaberg et al ., 2003) as this is suitable to the nature of females and their family responsibilities and their need for more time for their social life also we must consider that few or even absence of the female doctors to act as role model in surgical careers is an important factors to discouraged them from theses specialties . This is in agreement with other studies having the same results (Sanfey et al., 2006; Carolyn et al., 2010 and Mwachaka and Mbugua, 2010). Higher female choices to Obstetrics& gynecology in Suez Canal University may be due to culture, social and religious factors which still affect the choice and practice of this specialty as many female patients prefer female doctor of Obstetrics& gynecology specially in rural areas and this agrees with another study which concluded that among general medical specialties female usually prefer Obstetrics& gynecology and pediatrics (Khader et al., 2008). Male choices were higher in the specialties that need surgical procedures or special techniques with significant differences in; General Surgery, Ophthalmology, ENT and Anesthesiology in both groups and Radiology in Suez Canal University. These specialties almost have heavy workloads but at the same time have more prestigious careers in the medical field, high income and high chance of successful private practice which males usually looking for, and this agrees with other studies (Azizzadeh et al.,2003 and Gargiulo et al ., 2006 ) . Factors considered during choosing the specialty are of greater importance to be known to understand the driven forces behind career choice; our study showed that the most important factor that was considered during choosing the specialty in Zagazig, faculty of medicine was family expectations which also was the 2nd highest one in Suez Canal faculty of medicine, and we were to some degree not surprised from that as there is still a great respect to the family and the view of parents in our community. This finding agrees with those other studies which concluded that family role can influence individuals’ career behaviors (Corkin et al., 2008 and Nedjat et al., 2006). Most of other factors under study were nearly similarly considered by the students and interns of both faculties with no significant differences between them except for career opportunities and role model of specialties. Career opportunities which was significantly higher in Zagazig faculty of medicine was co ordinating with their 1st choice (General Surgery) and this is in agreement with another study conducted to detect reasons that could affect students' decision to pursue surgical specialties as a career, where, “prestige” and “career opportunities” were found to be highly positive aspects (Fukuda and Harada, 2010). Role model in the specialty which was significantly higher in Suez Canal University group was explained by several studies that stated that the accreditation may affects staff members' leadership and their better understanding of their job contribution (Davis et al., 2007). Also early and great interaction between them and their students which has a great influence on them when choosing a specialty. Conversely, lack of role models can leave medical students without the drive to pursue a career that they might otherwise have been interested in. Research findings showed that of all the sources of information available to medical students, role models were the most important specially when this role model is from the same sex of the student (Bundaberg et al ., 2003 and Mwachaka and Mbugua, 2010). Controllable life style related specialty, was stated by high percentage of our participants and this may indicate that the ability to control lifestyle is becoming increasingly important in the decision making process of medical students and this agrees with the results of a study done at three medical schools where the number of students selecting a specialty with a controllable lifestyle significantly increased while intake to the specialties with non-controllable lifestyles significantly dropped (Salter, 2007). Also we can found that opportunities to do procedure, high and stable income, prestige of specialty have high percent, while type and number of patients served has the least percent in both groups and also this agrees with other studies that found that factors most likely to influence the specialty choice decision-making process were types of procedures and techniques involved exposure to a positive role model in the specialty, and ability to balance work and personal life (Fukuda and Harada, 2010).

19 Curr. Sci. Int. 1(1): 12-19, 2011

Regarding gender differences in factors underlying specialty choice we can found that there were significant differences in nearly all factors in both groups except for family expectations in Zagazig faculty of medicine and role model of specialty in Suez Canal faculty of medicine with higher male percentage in factors related to the future of the career as career opportunities, ability to establish one’s own practice (private), strength in job market, high and stable future income and prestige of specialty. While females are more likely to consider other factors as; no or little work related hazards of infection, training period is easy and short, type and number of patients served and life style related to specialty is controllable from which we can notice that the female beside their thinking in their career and future jobs they also give great interest to their social and personal life when deciding to chose the specialty. We also noticed that there was no great differences in these factors between the two faculties as social factors are the main driven ones. This gender difference agrees with other studies which has nearly the same results (Gjerberg, 2002; Wendel et al., 2003 and Mwachaka and Mbugua, 2010). Also we noticed that about half of our male students (49.7%) in Zagazig faculty of medicine and (50.0%) in Suez Canal faculty of medicine were considering the controllable life style related to specialty . This indicates that even males think that life style and social life are among the important factors to be considered during choosing the specialty. From all above finding we can notice that the specialty choices and factors underlying them were nearly the same in the accredited faculty of medicine (Suez Canal University) and the non-accredited one (Zagazig University), this may be explained by the social role that has a great effect which was considered the same between both faculties. Also, faculty of medicine, Zagazig University has several steps in its way for seeking accreditation.

Conclusion and Recommendation:

Our study revealed similarities and differences in specialty preferences and factors influencing these choices among male and female students in both faculties. From all these factors we can found that the main factors which affected the specialty choices were; students' interest in the career and social aspects and responsibilities with unclear role of accreditation in choosing specialty. This study can serve as a pilot for future, more comprehensive studies following up the students from the early years in medical school to the actual time they choose the specialties. Also, those factors affecting specialty choices which are related to educational process must be more promoted by faculties' specially in specialties which may have deficient number of physicians. There is also a need for increasing awareness between medical students and interns about career choices in order to match the career preferences of students with the demands of the labor market. We also recommend conducting further studies to detect the effects of accreditation on career choices of medical students.

Limitations of the study:

Our study have the following limitations: scarcity of national data and researches about specialty choices and factors underlying them and finding the effects of accreditation on the students' choices represented a great difficulty for us to compare our results with other national ones. Also, this study was conducted in only two faculties of medicine, we think it must be perfumed national wide to get a complete picture about specialties and factors affecting them. Lastly factors under study may be expanded to analyze other factors related to demographic characteristics and educational system.

Acknowledgements

The authors are very grateful to those students and interns who participated in this study.

Authors contributions:

Omnia.S.El seifi designed the study methodology and the questionnaire, analyzed the data statistically and wrote the manuscript. Eman M. Mortada conducted the practical phase, and submitted the paper. Both authors revised the manuscript and have seen and approved the final version.

References

Anzllotti, K., D.S. Kamin, J.H. Sunshine and H.P. forman, 2001. Relative attractiveness of diagnostic radiology: assessment with data from national residency matching program and comparison with strength of the job market. Radiology, 221: 87-91. Aslam, M., A. Ali, T. Taj, N. Badar, W. Mirza, A. Ammar, S. Muzaffar and J.R. Kauten, 2011. Specialty choices of medical students and house officers in Karachi, Pakistan. EMHJ., 17(1): 74-79.

20 Curr. Sci. Int. 1(1): 12-19, 2011

Azizzadeh, A., C.H. McCollum, C.C. Miller, K.M. Holliday, H.C. Shilstone and A. Lucci, 2003. Jr. Factors influencing career choice among medical students interested in surgery. Curr Surg, 60: 210-213. Brotherton, S.E., P.H. Rockey and S.I. Etzel, 2004. US graduate medical education, 2003–2004. Journal of the American Medical Association, 292: 1032-1037. Bundaberg-Fischer, B., R. Klaghofer, T. Abel and C. Buddeberg, 2003. The influence of gender and personality traits on the career planning of Swiss medical students. Swiss Med Wkly. 133(39-40): 535-540. Caminal, J., B. Starfield, E. Sánchez, C. Casanova and M. Morales, 2004. The role of primary care in preventing ambulatory care sensitive conditions. European Journal of Public Health, 14: 246-251. Carolyn, E.R., A.V. Ara, E. Clease, J.D. Michael, J.C. Andrea, J.G. Kristine and H.M. Walter, 2010. Factors Dominating Choice of Surgical Specialty. J Am Coll Surg 2010; 210:319–324. © 2010 by the American College of Surgeons. Corkin, D., C. Arbona, N. Coleman and R. Ramirez, 2008. Dimensions of career indecision among Puerto Rican college students. J Coll Stud Dev., 49: 81-94. Davis, M.V., J. Reed, L.M. Devlin, C.L. Michalak, R. Stevens and E. Baker, 2007. The NC accreditation learning collaborative: Partners enhancing local health department accreditation. Journal of Public Health Management and Practice, 13: 422-426. Dorsey, E.R., D. Jarjoura and G.W. Rutecki, 2005.The influence of controllable lifestyle and sex on the specialty choices of graduating US medical students, 1996–2003. Acad Med., 80: 791-796. Fukuda, Y. and T. Harada, 2010. Gender differences in specialty preference and mismatch with real needs in Japanese medical students. BMC Medical Education., 10: 15-22. Gargiulo, D.A., N.H. Hyman and J.C. Hebert, 2006. Women in surgery: do we really understand the deterrents. Arch Surg., 141: 405-407. Gjerberg, E., 2002. Gender similarities in doctors’ preferences and gender differences in final specialisation. Soc Sci Med., 54: 591-605. Global standards for excellence in education. Accreditation, April 2011. http://www.advanc-ed.org/what- accreditation Huda, N. and S. Yousuf, 2006. Career preference of final year medical students of Ziauddin Medical University. Education for Health (Abingdon, England), 19: 345-353. IBM. IBM SPSS Statistics 19 Core System Users’ Guide. Chicago: SPSS Inc.; 2010. http://www.IBM-SPSS- Statistics-User s-Guide.pdf. Khader, Y., D. Al-Zoubi, Z. Amarin, A. Alkafagei, M. Khasawneh and S. Burgan, et al., 2008. Factors affecting medical students in formulating their specialty preferences in Jordan. BMC medical Education., 8: 32. Mwachaka, P.M. and E.T. Mbugua, 2010. Specialty preferences among medical students in a Kenyan university. Pan African Medical Journal., 5: 18. National Authority for Quality Assurance & Accreditation of Education –Egypt (NAQAAE). June 2011. < http://www.naqaae.org.eg/>. Nedjat, S., H. Emami-Razavi, A. Rashidian, S. Yazdani and S. Majdzadeh, 2006. Factors associated with choosing medical school among students of Tehran Faculty of Medicine and their awareness about future of their career: a qualitative-quantitative approach. Steps Dev Med Edu. , 3: 1-10. Pei, Y.C., Y.H. Chih, I.W. Kuei and J.C. King, 2006. Factors Influencing Medical Students’Choice of Specialty. J Formos Med Assoc., 105(6): 489-496. Salter, A., 2007. Gender and choosing a specialty. Student BMJ., 15: 313-314. Sanfey, H., S. Saalwachter, Y. Nyhof, B. Eidelson and B. Mann, 2006. Influence on medical student career choice: Gender or generation? Arch Surg., 141: 1086-1094. Scott, I.M., A.N. Matejcek, M.C. Gowans, B.J. Wright and F.R. Brenneis, 2008. Choosing a career in surgery: factors that influence Canadian medical students’ interest in pursuing a surgical career. Can J Surg, 51(5): 371-377. Wendel, T.M., C.V. Godellas and R.A. Prinz, 2003. Are there gender differences in choosing a surgical career? Surgery, 134: 591-598.